- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, ... organization, professional organizations, and community health care facilities concerning Utilization Management . + Participates in in-services and continuing… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse ! Job...+ Clinical review + Utilization review + Utilization management + ... Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and… more
- Access Dubuque (Dubuque, IA)
- Utilization Management Nurse **Cottingham & Butler/ SISCO** 1 Positions ID: 4627707008 Posted On 07/01/2025 **Job Overview** ** Utilization Management ... - Dubuque, IA UnityPoint Health Finley Hospital Experienced Sales Executive - Risk Management Cottingham & Butler/ SISCO Home Care Nurse Residency, Dubuque Iowa… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity ... of services and care. * Provides referrals to Case management , Disease Management , Appeals & Grievances, and...a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract… more
- CVS Health (Carson City, NV)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review… more
- Veterans Affairs, Veterans Health Administration (Los Angeles, CA)
- …(VAGLAHS) is seeking to hire experienced Registered Nurses to work in our Utilization Management (UM) Program. Incumbents are expected to perform assessing, ... the following: Demonstrates ability to perform a wide range of Utilization Management /Quality Management /Performance Improvement (UM/QM/PI) activities that… more
- McLaren Health Care (Pontiac, MI)
- …requirements _Preferred:_ + Bachelor's degree in nursing + Experience in utilization management /case management /clinical documentation, critical care, or ... **Position Summary:** Responsible for Utilization and Care Management services to...on all patients reviewed in the ED. Conducts initial review using InterQual, MCG and other tools, assists provider… more
- US Tech Solutions (Canton, MA)
- …all aspects of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using ... criteria through participation in the IMPAC. + Proactively identifies trends in Utilization Management applicable to the precertification and outpatient UM… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,...state, local, and federal programs + Progressive knowledge of utilization management , case management , performance… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The ...Skills + Clinical review + Utilization review + Utilization management + Interqual ... Utilization Management Nurse (UMN) plays a crucial role in reviewing service...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
- CVS Health (Denver, CO)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a… more
- St. Peters Health (Helena, MT)
- The Utilization Management Nurse reports directly to Utilization Review RN Coordinator. The UR Nurse supports the UR RN Coordinator in providing ... for the organization and is responsible for ensuring complaint utilization and cost-effective care delivery. The UR Nurse...serves as a collaborative and supportive liaison and educator to providers and staff around utilization management … more
- AdventHealth (Glendale Heights, IL)
- …avoidance strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated ... 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse ...of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,… more
- WellSpan Health (York, PA)
- …collection and analysis of utilization patterns and denied cases. + Supports the Utilization Management Nurse with case research and analysis. + Works ... Provides feedback to payer contracting regarding payer actions that cause barriers to the utilization review process. + Maintains up to date tip sheet on… more
- AmeriHealth Caritas (Newark, DE)
- …**Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity ... times, quality benchmarks, and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon… more
- AmeriHealth Caritas (Washington, DC)
- **Role Overview** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... overtime, and weekends based on business needs **Responsibilities** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Integra Partners (Troy, MI)
- …individual situation or the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case to the ... Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our... Review Medical Director to support our Utilization Management team. This is a salaried,… more
- AmeriHealth Caritas (Philadelphia, PA)
- …pediatric patients in a clinical setting + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization + Experience ... **Role Overview** Under the direction of the unit Supervisor, the Clinical Care Reviewer - Shift Care is responsible for managing requests for pediatric shift care… more